Maryland’s Developmental Disabilities Administration (DDA) which comes under MD Department of Health is currently undergoing a transition pertaining to the Medicaid services and billing methods for organizations providing Long-Term Services and Supports.
This is an important topic since billing is now shifting from a prospective payment system to fee-for-services billing (i.e. a reimbursement model).
Through this new model, service providers will be able to view and approve services they will provide to support the Person-Centered Plan, and enter service activities for billing.
As per the transition, Maryland’s DDA has already started a pilot in December 2019 to test out the new LTSS system and billing method with selected providers and partners. iCM is working closely with the DDA and with various providers to undergo these pilot programs in order to be ready for the LTSS rollout later this year.
The DDA and providers are working on an LTSS transition plan, and we anticipate that LTSS is geared to go live for many providers in July 2020 with a fully operationalized use of LTSS by Service Providers to view, accept service referrals, and bill for service. The details of the full rollout are still in the works. The major tech functionalities required for this include: PCP electronic acceptance by service providers and claim entry and/or upload for billing.
DDA member organizations provide a coordinated service delivery system to enable children and adults with intellectual and developmental disabilities and families to work toward self-determination, interdependence, productivity, integration, and inclusion in all facets of community life across their lifespans. As such, understanding this transition (and being ready for it) is crucial for all such organizations to be able to ensure uninterrupted continuity of their services to the community.
iCM provides software for secure, web-based documentation, communication and electronic billing for providers of long term services and supports; with integrated PCP based billing modules. Since it benefits everyone to be on the same page with regards to this LTSS Billing transition, we’ve been actively conducting workshops and sharing insights and information. We’d be happy to guide you further if you require any assistance or have any questions.
For now, we’d like to share a few tips on how you can make this all-important implementation more efficient, more pleasant, and — most important — highly successful.
- Remind yourself of the big picture. In a nutshell, you have two goals. A- Continue to provide (and improve) support for people under your organization’s responsibility, without interruption. B- Receive the funding necessary to allow that to happen, without interruption.
- Design a workflow. Executives and key managers have a great opportunity to design better workflows. This is a chance to refocus on what you’re already doing: Person-Centered Planning, and make it work for you to overcome barriers within a changing landscape.
- Build in Alerts for PCP misalignment. When a PCP process is falling off track, when a plan for any person needs to be modified, your staff need to know where to focus their efforts to get things back on track. Make sure the software you’re using can efficiently and meaningfully alert them.
- Choose the right software. Settle early on the core functions the software must perform for your organization, and stick to them. After a discussion with other key members of your organization, settle on a core list of must-haves, as it relates to LTSS Billing requirements and the service needs of people under your purview of support.
- Build in alerts for when service is falling behind in hours in a given month. Billing hours are a clear and reliable metric for properly pacing support since support is tied to billing. So, this is a perfect example of how the new LTSS billing requirements can assist us in serving people better. And, making sure your agency is billing for the services you are providing. Your billing software can enable your staff to see utilization in real-time, so this can be managed throughout the month, rather than after the opportunity to bill is missed.
- Find an easy way to generate necessary reports. Here are some of the reports you’ll need: Tracking the alignment with authorizations of services delivered + Generating the PCPs along with your staff’s notes appended to them. Also, reports on where dollars for a certain PCP are spent, all of it tied to authorizations. You’ll also need to generate a Provider Implementation Plan to forward it to the Coordinator of Community Services. And finally, in this short suggestive list, service notes for billing justification.
- You’ve got this. You just need a good plan, a good workflow, and the right software. When you meet this challenge in July 2020, you’ll feel good. You’ll see that you’ve kept your two goals front and center, and met them both: continued and improved support, and the necessary job that makes that possible, effective and compliant reporting and billing.